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Monitoring the anesthetized patient (E1) Flashcards

1
Q

What is the best equipment for monitoring the patient?

A

YOU YOU BIG JABRONEE

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2
Q

What do we monitor when anesthetizing a patient?

A 
anesthetic depth 
body temperature 
circulation 
ventilation 
oxygenation (circulation and ventilation combo)
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3
Q

What are the three most important aspects to monitor?

A

Oxygenation
Circulation
Ventilation

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4
Q

What do we look at to monitor anesthetic depth?

A 
Eye position 
Reflexes 
Muscle relaxation 
Movement 
EtCO2
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5
Q

What is the eye position for a properly anesthetized dog, cat, or calf?

A

Rolls ventrally; unmoved means they are too heavy/light

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6
Q

What is the eye position for a properly anesthetized horse?

A

WHO KNOW! Unreliable.

Nystagmus/tearing = too light

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7
Q

What are some reflexes we test?

A

Palpebral
corneal
Withdraw

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8
Q

T/F The corneal reflex should be absent in a properly sedated patient

A

NO! This means they’re dead

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9
Q

How do you test the palpebral reflex for dogs/cats? Horses? What do you see for each?

A

Dogs: tap medial canthus; absent
Horse: brush cilia, slow closure of eye present

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10
Q

What drug can cause the jaw to tighten when administered?

A

Ketamine

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11
Q

What is MAC and why is it important?

A

Minimum alveolar concentration; the concentraiton of inhalant in the lungs needed to prevent movement in 50% of patients

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12
Q

A low MAC means what?

A

The drug is very potent

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13
Q

What is key about MAC x 1.5?

A

95% of patients are anesthetized at this level

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14
Q

What is the MAC of Isoflurane for dogs/cats/horses

A

Dogs: 1.28%
Cats: 1.63%
Horses: 1.3%

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15
Q

What is the MAC of sevoflurane for dogs/cats

A

Dogs: 2.3%

Cats: 2.6%

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16
Q

What can we measure that represents the level of anesthetic in the brain of patients?

A

End tidal concentration

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17
Q

normal respiration is controlled by what?

A

Arterial levels of CO2

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18
Q

EtCO2 is usually how much lower than PaCO2?

A

3-5 mmHg

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19
Q

EtCO2 should be kept below what when anesthetized?

A

60 mmHg; 40 mmHg in normal patients

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20
Q

Delivery of O2 to tissues can be calculated how?

A

CO x Oxygen content of blood (CaO2)

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21
Q

T/F Capillary refill time is key tool to assess anesthetic depth

A

FALSE; would never run this test in an anesthetized patient

22
Q

T/F Pulse pressure is a good indicator for Mean arterial pressure

A

FALSE

Pulse pressure is SAP-DAP
this difference can be affected by drugs ie Ketamine- causes weak pulse but the Mean Pressure is still high

23
Q

What is the gold standard of blood pressure monitoring?

A

Arterial catheter

24
Q

What are the two ways we can indirectly measure blood pressure?

A

Doppler

Oscillometric

25
Carbon dioxide is directly linked to a patient's:
metabolism, perfusion, and ventilation
26
Minute ventilation can be calculated by what? Is it a good indicator of ventilation?
Tidal volume X frequency NO
27
What is the most useful tool to detect apnea and hypoventilation
End tidal CO2
28
The measure of pCO2 is called what?
Capnography
29
What are the two different ways to measure pCO2? (location of the sensor)
Mainstream: measurement device is between ET tube and breathing circuit Sidestream: sampling device is between ET tube and breathing circuit
30
What is the key consideration when using the sidestream sampler?
Low flow rates; could pull all the O2 out of the system
31
What are some causes of high EtCO2?
Hypoventilation, fever, increased CO, exhausted soda lime
32
What are some causes of low EtCO2?
hypothermia, DEcreased CO, hyperventilation, patient disconnect
33
What is a decrease in PaCO2 classified as? Increase?
Respiratory alkalosis | Respiratory acidosis
34
Pulse oximetry is a good way to measure what?
Pulsatile arterial blood in tissue bed
35
Where would the ideal SpO2 be for an anesthetized patient? What is a danger level?
Ideal is 93-95% Less than 90% is at risk for hypoxemia
36
How can PaO2 be estimated?
SpO2 - 30;
37
T/F PaO2 is most helpful when the patient is breathing room air or transitioning
TRUE we dont use this measurement for patients under general anesthesia
38
T/F Dark pigmented skin can affect a pulse oximeter reading
TRUE
39
Cats can experience hyperthermia when given what class of drugs?
Opioids
40
Intermittent positive pressure ventilation should be used when:
Intra-thoracic surgery Head trauma/brain tumor All horses
41
T/F You always wean horses from IPVV?
FALSE; never wean them unless brain surgery/ head trauma you would decrease the inhalant
42
What are the two ways to wean a patient from IPVV?
Lower respiratory rate to increase PaCO2 | Discontinue inhalant to decrease CO2 set point in brain
43
What strategy for weaning would you use for a patient presenting with a head trauma or tumor?
ONLY Decrease the inhalant NEVER lower the resp rate
44
T/F Anesthetics are dose dependent cardio vascular and respiratory depressants, and as such need to be titrated to the lowest effective concentration
TRUE
45
A horse wakes up in the middle of Sx right after you just checked for a palpebral reflex (which was absent) what most likely happened, and what should you have noticed prior to the animal waking up?
Horse is on its back isnt it? Swelling of the head during surgery will depress the reflex you should have noticed nystagmus or tearing which are both indication of a light plane of anesthesia in horses
46
You should begin anesthesia with a _____ flow rate and then switch to ____
High flow rate lower/maintenance rate, remember we titrate back
47
____ is the KEY to patient survival
DO2- delivery of Oxygen to tissues
48
What is the threshold for Pulse rate of Dogs/Cats?
>60 in dogs >80 in cats below is considered bradycardia
49
Accuracy of oscillometric machines is dependent on ____; if it is too small the machine will ____ BP; if too big the machine will ___ BP
Cuff size too small -> overestimate too big -> under estimate
50
T/F A arterial catheter is placed in all surgeries involving cattle or horses
TRUE
51
T/F The sole benefit of using a pulse oximeter is that it calculates the SpO2 of the blood in the peripheral tissues, which is directly correlated with lung function
FALSE Pulse ox tells you jack shit about lung function, it one of the limiting things about it.

Anesthesiology (13 decks)

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